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PERMIT APPLICATIO" <br />BUILDIN�ECHANICAL / PLUMBING / SIGML�RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE ADDRESS: � � � � <br />PROJECT SITE INFORMATION <br />� � PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER NAME: � �� �-�O <br />OWNER MAILING ADDRESS: <br />OWNER PHONE: � ��` � <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: <br />g.� ad f-�� � <br />STREET Q� Q I I <br />e <br />cirr ,��1—��� <br />'� - G�o� <br />CONTACT INFORMATION <br />TENANT NAME (If Commercial): ��d�� <br />�7�L../� � f ��e J d fv �i��J <br />��� C. �� 1���� <br />STREET �� 3 � d� � <br />STATE <br />OWNER EMAIL: �)Zly¢� � <br />�� <br />93� � lf� _. <br />o �'� ziP <br />r�$C/o�r�r�/� <br />�� � <br />/�L�� <br />CITY � �. j�p. I(0�9�' �� � STATE ZIP <br />CONTRACTOR PHONE: �4�,3 �- �p t- �'S� �� CONTRACTOR EMAIL: � fdss��?►,,S`d��9�C`,� �' � ��ul,i� i,;�� . �Jt'"y, <br />CONTRACTOR LICENSE #(REQUIRED): �� ��S� 9 ���9� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): Q� <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR [��HER (Please Specify) ���� �9�°� � <br />CONTACT NAM : � ' CONTACT PHONE: � �-� �� - �'� <br />`fb� Rdt3�2d � � ���� ����� -�q9fl(� ��p� CONTACT EMAIL: �FZ� � � �4���FZ ��� . �� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $i � <br />�+, <br />Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: C�ommercial ❑Industrial <br />T pe of Pro�ect: ❑New ❑Addition ❑Remodel ❑Repair � .� ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: f,$- rL�b � � ��9 �. � � �'� <br />� P' ����,, ol„v�6�B t�F✓� �'iaa� � � ��� <br />� �( �f,,���� s� ; i A� � � cv�.v�o���cl l s��a �-/ ���c�'�I �3 c�ltti7i�� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fixtures # of List of Fixfures # of List of Fixtures <br />Fixtures Fixtures Fixtures Fixtures <br />A/C - Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldg) <br />Forced Air Systems Unit Heater Bathtub Urinal <br />Gas Piping Boiler Lavatory (Wash Basin) Drinking Fountain <br />Water Heater Refrigeration Shower Floor Drain <br />Gas Fireplace Wood Stove Kitchen Sink & Disposal Grease Trap <br />Gas Range Ducting Dishwasher Roof Drains <br />Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br />Range Hood Water Heater Other: <br />Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: I have �eviewed this application and confirm the information contained herein is frue and correcL Work done pursuant to this permit must comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing irom the <br />Building Official before being authorized under any circumstance. I am the owner, or 1 am authorized by the ownei of this property fo perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Onty <br />� � �z_v._--__W.._e_.___------_ �T � _ �� �� PERMI � � <br />�' L- �� <br />,; <br />OwnerlAuthorized Agent ignature Date (Revised 10 12/201 t L <br />